UA Researchers Look to Stem the Growth of Tobacco Use Worldwide

Sunday is the World Health Organization’s World No Tobacco Day.

The focus of WHO’s campaign this year is the effectiveness of warning labels in getting people to stop smoking and using other forms of tobacco. Since warning labels first appeared on cigarette packs more than 40 years ago, Americans have generally taken these warnings to heart.

In the rest of the world, it’s a different story, especially in developing countries where smoking and other tobacco use is on the rise.

“Warnings are fine and make sense in Western countries,” said Mark Nichter, a Regents’ Professor of anthropology at The University of Arizona. “But we’re doing something different.”

Nichter and two colleagues – his wife, Mimi Nichter, an associate professor of anthropology, and Myra Muramoto, an associate professor of family and community medicine – have been trying to stem the growing tide of smoking and other tobacco use in two of the most populated countries in the world, India and Indonesia.

Seven years ago they formed Project Quit Tobacco International along with their research partners at the Achutha Menon Centre in South India and the Gadjah Mada University in Indonesia. The project is a pioneering attempt to develop what they call “culturally appropriate approaches to tobacco cessation within the health sectors of India and Indonesia.”

Those two countries, along with China, represent a large and growing market for tobacco companies. China, for instance, has more smokers than the United States has citizens, said Scott Leischow, a professor of family and community medicine at the UA and associate director for behavioral and social science research at the Arizona Cancer Center.

Leischow, who is also the past president of the Society for Research on Nicotine and Tobacco, said women in China also represent a tiny but rapidly growing cadre of smokers.

Project Quit Tobacco aims to work on tobacco cessation by introducing the topic at ground zero: medical schools and clinics in India and Indonesia. The project has received a second round of grant funding worth $1.5 million from the Fogarty International Center, part of the National Institutes of Health.

“We need to change the norms of the medical profession,” said Mark Nichter. “We’re trying to get schools to introduce tobacco at every level of study.”

Doctors in Third World areas, he noted, often are smokers themselves, which seriously undermines any efforts to get their patients to give up tobacco.

Worldwide, he said, tobacco use is among the greatest causes of preventable death and disease. “Approximately 500 million people alive today will die because of tobacco,” Nichter said.

“In terms of its significance as a global health issue, tobacco smoking kills more people than malaria, maternal and major childhood conditions, and tuberculosis combined,” he said.

He added that by 2030, the annual number of deaths caused by tobacco will rise to 10 million, with half of these deaths occurring among the 35-69 age group.

“As a consequence, smoking will be the cause of one-third of all deaths in the next 20 years,” Nichter added.

Most tobacco-related deaths will occur in India, Indonesia and China, where smoking and chewing is on the increase. Almost 70 percent of the men in Indonesian are smokers and about half of the men in India use some form of tobacco.

While tobacco use in the U.S. is associated with cancer, in Third World countries tobacco use is a major risk factor for tuberculosis and diabetes. Those who have had tuberculosis and continue to smoke are far more likely to relapse. Smoking also exacerbates diabetes symptoms, especially heart disease.

Project Quit Tobacco also is developing “culturally sensitive counseling” that is designed to appeal to men’s responsibility toward their families. Smoking and tobacco use can consume a significant part of a family’s resources, not only to purchase products but to pay for health care costs related to tobacco use.

Scott Leischow said it isn’t unusual for a family to spend 15 to 20 percent of its income on tobacco.

“In a low-income country, that’s money that is not being spent on food, shelter or medicines they need. It’s an economic burden globally,” he said. “The challenge is that once a person starts smoking, it’s a highly addictive condition – an addictive as heroin, cocaine or alcohol – and it’s difficult to stop.”

Nichter said one goal is to emphasize to men that giving up smoking is a heroic, selfless act that benefits their families.

“We also want to turn this into a women’s issue. Women should also encourage men to stop to lessen the harm done by smoking,” he said.

Nichter said the potential to save lives globally through aggressive cessation initiatives has been well-documented. “By the year 2020, if adult consumption were to decrease by 50 percent, approximately 180 million tobacco-related deaths could be avoided.”

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